Healthcare ratings continue to proliferate. But fewer Americans recall seeing and using them.

Between 2006 and 2008, the percentage of Americans who reported that in the past year they "saw" and "used" comparative health quality information for health insurance plans, hospitals or doctors dropped by 6 percent. (From 20 to 14 percent)

This finding came as part of the Kaiser Family Foundation's 2008 Update on Consumers' Views of Patient Safety and Quality Information. In the same study, the percentage of Americans who said they "saw" that same type of information fell from 36 to 30 percent.

The implications are huge.

As government continues to gather and publish data in the hope of driving efficiency and cost savings through informed free-market forces, fewer citizens are participating.

As health insurers increasingly generate information to empower consumer-driven healthcare, awareness and use are diminishing.

As hospitals and health systems seek to differentiate themselves based on quality data, not as many consumers are noticing.

Why are fewer Americans tuning in?

In 2006, in an article published in Healthcare Marketing Report and in speaking engagements, I warned of factors that would undermine the effectiveness of quality ratings: exploitation and overexposure in marketing, too many sources with no standardization, needless complexity with lack of interpretation, or oversimplification that betrayed the underlying data. The result would be a lack of understanding by consumers, resulting in tune out. It seems to be coming true.

Providing comparative healthcare information and encouraging its use is essential. The two-year downtrend shows that we have lot of work to do. Consumers can't gain insight from comparative healthcare quality information if ratings go sight unseen.